Etiology

Peptic ulcer disease:

• Most common cause of stomach and duodenal perforation

• Duodenal ulcers of the anterior wall are more likely to perforate.

Malignancy

Inflammatory bowel disease: ulcerative colitis, Crohn disease

Diverticulitis (colonic diverticula, Meckel diverticulum)

Acute appendicitis

Typhoid

Gastrointestinal tuberculosis

Toxic megacolon

Inflammatory bowel disease

Bowel ischemia

• Bowel obstruction (i.e., adhesions, volvulus, malignancy)

• Acute mesenteric ischemia

Trauma

• Penetrating trauma (e.g., stab injury, iatrogenic perforations): e.g., post-ERCP duodenal perforation

• Blunt abdominal trauma

Miscellaneous

• Foreign body ingestion

• Drug-induced (e.g., NSAIDs, glucocorticoids, cocaine)

• Radiation therapy to the abdominopelvic or lower thoracic region

• Post renal transplant